摘要
目的:测量后路寰枢椎融合手术对颈椎矢状面参数的变化,并对其相关影响因素进行评估。方法:回顾性研究2015年1月~2017年12月收治的寰枢椎脱位病例18例,男8例,女10例,年龄25~72岁,平均49.6±13.7岁。所有寰枢椎脱位患者均行单纯后路复位C1~C2固定融合术,随访时间为5~17个月,平均7.4±3.7个月。测量患者术前和末次随访时的枕颈角(C0~C2角)、下颈椎前凸角(C2~C7角)、颈椎前凸角(C0~C7角)、颈椎矢状面轴向垂直距离(C2-C7 sagittal vertical axis,C2-C7 SVA)、C1~C2角、T1倾斜角(T1 slope,T1S)、颈部倾斜角(neck tilt,NT)和胸廓入口角(thoracic inlet angle,TIA)等颈椎矢状面参数。在末次随访时,术后C2~C7角比术前减小的病例归为下颈椎前凸曲度减小组(5例),而术后C2~C7角比术前增加或不变的病例纳入下颈椎前凸曲度增加组(13例)。采用卡方检验做下颈椎前凸曲度减小与性别、年龄(以60岁为界限)、术前T1S(以25°为界限)、术前C2-C7 SVA(以15mm为界限)、术前TIA(以70°为界限)、术前C2-C7角(以20°为界限)、术前C0-C2角(以20°为界限)、术前C0-C7角(以45°为界限)和术后C1-C2角(以20°为界限)等临床因素相关性的单因素分析。采用Logistic回归对术后下颈椎前凸曲度减小的相关因素进行多因素分析。结果:所有患者术前和末次随访时的C0~C2角分别为21.6°±16.4°和28.3°±8.6°、C2~C7角分别为15.3°±12.9°和16.4°±11.1°、C0~C7角分别为36.8°±19.7°和44.9°±13.2°、C1~C2角分别为12.4°±17.6°和17.5°±7.3°、C2~C7 SVA分别为13.4±14.7mm和15.1±11.7mm、T1S分别为22.8°±8.2°和23.5°±7.3°、NT分别为50.8°±9.5°和51.9°±8.9°、TIA分别为73.6°±11.1°和75.4°±10.0°,以上这些颈椎矢状面参数在术前与末次随访的比较均无显著性差异(P>0.05)。对两组患者术前和末次随访的颈椎矢状面参数进行比较,前凸减小组的术前C2~C7角明显大于前凸增加组(27.6°±10.5° vs 10.5°�
Objectives: To measure the changes of cervical sagittal parameters and evaluate the related factors after posterior atlantoaxial fusion. Methods: Eighteen patients (aged 25-72 years with mean age of 49.6±13.7 years) with atlantoaxial dislocation in Fuzhou Second Hospital Affiliated to Xiamen University between January 2015 and December 2017 were retrospectively analyzed. There were 8 males and 10 females patients. All patients with atlantoaxial dislocation underwent simple posterior reduction and C1-2 fixation. They were followed up for 5 to 17 months, with an average of 7.4±3.7 months. Cervical sagittal parameters including C0-C2 angle, C2-C7 angle, C0-C7 angle, C1-C2 angle, C2-C7 SVA, T1S, NT and TIA were measured before surgery and at the last follow-up. Chi-square test was used to analyze the relationship of lower cervical curvature lordosis and gender, age (bounded by 60 years old), preoperative T1S (bounded by 25°), preoperative C2-C7 SVA (bounded by 15mm), preoperative TIA (bounded by 70°), preoperative C2-C7 angle (bounded by 20°), preoperative C0-C2 angle (bounded by 20°), preoperative C0-C7 angle (bounded by 45°) and postoperative C1-2 angle (bounded by 20°). At the last follow-up, the subaxial lordosis loss group (5 cases) included the patients whose postoperative C2-C7 angle was reduced, and the subaxial lordosis increase group (13 cases) included the patients whose postoperative C2-C7 angle was increase. Logistic regression analysis was applied to analyze the factors related to the postoperative loss of subaxial lordosis after posterior atlantoaxial fusion. Results: The cervical sagittal parameters of preoperation and last follow-up were as follows respectively: C0-C2 angle 21.6°±16.4° and 28.3°±8.6°, C2-C7 angle 15.3°±12.9° and 16.4°±11.1°, C0-C7 angle 36.8°±19.7° and 44.9°±13.2°, C1-C2 angle 12.4°±17.6° and 17.5°±7.3°, C2-C7 SVA 13.4±14.7mm and 15.1±11.7mm, T1S 22.8°±8.2° and 23.5°±7.3°, NT 50.8°±9.5° and 51.9°±8.9°, TIA 73.6°±11.1° and 75.4°±10.0�
作者
刘少强
黄清奇
齐强
梁珪清
陈伟
刘伯龄
王华锋
陈齐勇
LIU Shaoqiang;HUANG Qingqi;QI Qiang(Department of Spine Surgery,Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, 350007,China)
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2019年第4期336-342,共7页
Chinese Journal of Spine and Spinal Cord
基金
福建省自然科学基金(编号:2018J01362)
福州市科技计划项目(编号:2016-S-123-17)
关键词
寰枢椎融合
下颈椎前凸曲度
矢状面平衡
因素分析
Atlantoaxial fusion
Subaxial lordosis
Cervical sagittal balance
Factor analysis
